A 45-year-old man has recurrent painful swelling of the left submandibular region during meals. Non-contrast CT of the floor of the mouth shows a small hyperdense focus within Wharton duct with proximal ductal dilatation. What is the diagnosis?

• A Submandibular sialolithiasis ✓
• B Pleomorphic adenoma of the submandibular gland
• C Submandibular space abscess
• D Second branchial cleft cyst

Explanation

Calculi are far more common in the submandibular gland than the parotid because Wharton duct is longer, has an uphill course, drains against gravity, and carries more alkaline mucinous saliva with higher calcium content. Meal-related swelling with a hyperdense calculus on non-contrast CT is diagnostic; about 80 percent of salivary calculi are radiopaque. A pleomorphic adenoma is a solid parenchymal mass, not intraductal, which kills option B.

Reference: Grainger and Allison's Diagnostic Radiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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